Opioid Epidemic

Legalizing Narcan, a life-saving overdose reversal drug

Marissa walks her dog Asali. She's been in recovery from her opioid addiction for two years.

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In the legislative session beginning Feb.1, Rep. Knute Buehler [R - Bend] will introduce a bill that would allow the opioid overdose reversal drug Narcan to be obtained without a prescription. The antidote, also called Naloxone, used to be solely injectable, but a nasal spray was introduced in 2015.

"The United States is in the midst of a prescription painkiller overdose epidemic," according to the Centers for Disease Control and Prevention (CDC). Moreover, "Heroin use more than doubled among young adults ages 18 to 25 in the past decade," says the CDC.

When the FDA approved the Naloxone nasal spray, it reported that more people die from drug overdose deaths than in car accidents—it's the number one cause of injury death in the United States.

"This is a much bigger problem than the crack epidemic from the 90s or the meth epidemic that we saw last decade," says Buehler, who is a medical doctor.

Oregon's high rate
ofabuse

"In 2012, Oregon had the highest rate of non-medical use of prescription pain relievers in the nation," according to the Oregon Health Authority's 2014 Drug Overdose Deaths, Hospitalizations and Dependency Among Oregonians report. The opioid epidemic continues to run rampant in lower income communities. According to the Center for Disease Control, there are 5.5 users per every 1,000 people who make $20,000 or less per year. It's on the rise among all demographics of men and women, regardless of race, age and health insurance coverage. The reality of the jaw-dropping prescription statistics: according to the CDC, 259 million prescriptions were written in 2012—enough for every adult in the U.S. to have access to a bottle of painkillers.

When monetary decisions outweigh a drug of choice, heroin is often the solution—it's cheaper, it produces the same high and it's not flagged by doctors tracking the amount of prescriptions being written. According to CDC research analyzing trend and risk factors among heroin users in 2015, CDC Director Tom Frieden said, "Heroin use is increasing at an alarming rate in many parts of society, driven by both the prescription opioid epidemic and cheaper, more available heroin."

The scope of the opioid crisis

"It's almost at epidemic proportions—especially in Oregon," says Buehler. According to Buehler, Oregon has one of the highest narcotic prescription written of any state in the nation. His proposal, "would allow Narcan to be out much more widely in the community so you could get ahold of it by going into a pharmacy without a doctor's prescription, [and] homeless shelters and sobering facilities would have Narcan on hand and anyone could deliver it," he explains.

Many people addicted to opioids never make it into recovery and overdoses continue to climb, in part because prescription drugs can be more accessible when people shop around for doctors. Buehler says the second part of the proposed bill includes a database, which will monitor prescribed drugs. "It exists [now], but it's not being used just because it's too difficult for providers to get through the I.T. part of it, so we are going to make it more accessible."

Buehler says the Oregon Board of Medical Examiners has a strict monitoring policy intended to track doctors who over-prescribe or inappropriately prescribe narcotics. "The Prescription Drug Monitoring Program (PDMP) and all the data already exist currently; our bill simply provides easier access and utilization of the existing information for providers. The intent is to help providers deliver better care while reducing opioid addictions," he says.

Facing addiction

Every weekday around 11:30 a.m., Marissa wakes up, takes her dog Asali for a walk, feeds her cats and eats breakfast. She then bikes or drives a few miles over a congested bridge into town to stand in line at a methadone clinic in her town. For the last two years, this routine has been a constant in her life when she decided to seek help for her opioid addiction.

"My daily routine isn't a very planned out routine, it just kind of happens," she says. "Since I work at night and sometimes I don't get home until three, four, or six in the morning from work, where I'd maybe like to sleep a few more hours, I can't." She doesn't often get a chance to do anything she enjoys like yoga or taking her dog on longer walks because once her methadone begins to kick in, the drowsiness forces her to take a nap. If she happens to be out grocery shopping or running errands, she says she'll have to slap herself in the face to stay awake while driving until she arrives at home. Sometimes she falls asleep while she's eating.

She began taking Lorcet and Percocet, later moving onto cocaine and then snorting heroin. Eventually, she tried injecting cocaine and prescription pills. The allure of nodding out, a high she says that many addicts aim for, wasn't her intention. She says her first experience felt like a roller coaster and for the next ten years of her life, her drug use slowly climbed, peaked, spiraled out of her control and abruptly halted a few times only to launch back into a slow and steady climb back to using every day and spending all of her money on drugs. The price of heroin, she says, is around $20 to $25 dollars for a tenth of a gram (100 milligrams), or one-fourth the price of the $1 per milligram that she paid for oxycodone. (She now spends $78 per week for her daily dose of methadone if she pays up front, and if she doesn't, it can be $98 per week.)

A Decade-long struggle

Opiod addiction began for Marissa with her first job as a hostess at a strip club. She then became a cocktail waitress and began drinking and using prescribed Lorcet to deal with her hangovers. After finishing her perscription she bought them from a bouncer for three dollars a pill. "I remember I would just give him 100 or 150 dollars at a time because I had plenty of money at the time," she says. "Thirty pills would last me a few weeks, maybe just a week, it depended on how much I was taking." That was when she became dependent on opioids for the first time—taking them every day.

A few years later, working as a dancer in 2008, she began taking an opioid called Roxy--30 milligram instant release oxycodone pills—to cope with her panic attacks, bouts of agoraphobia and back pain. "I took a Percocet here and there, and I just remember how good it made me feel," she says. "At the time I could take a quarter of one of those pills and get high from it. Every day that I would work I would take one. Then I started taking one when I got up; then I started snorting them, too."

The nadir of Marissa's drug use came after injecting cocaine. Days after injecting, her arms became red and swollen, landing her in an emergency room. She was prescribed antibiotics, but the pain and redness didn't subside. When she went back to the emergency room a different doctor told her it was likely inflammation of the blood vessels.

Addiction to opioids can increase chronic pain and at one point Marissa sought help for extreme back pain. She asked one doctor to order her an MRI and he refused. As she was seen at different doctors' offices and in the emergency room over the years, she says doctors didn't believe she was experiencing pain and no medical professional ever suggested she seek help for addiction. "No one ever told me that I should get help or ever flat told me, 'I think that you're an addict, you need to get help, here's phone numbers that you can call.' That never occurred," she says. In 2014, Marissa knew she needed help. She asked about treatment options for her opioid addiction in an emergency room.

Efforts and solutions

In September, CVS Pharmacy announced that it would carry Naloxone, (sold under the brand name Narcan), the overdose reversal nasal spray, without a prescription in 12 states in addition to Rhode Island and Massachusetts. Mike DeAngelis with CVS says people can place a standing order for Naloxone, which allows the drug to be ordered and arrives the next day so people can have access in case of an opioid overdose. "Standing order agreements [are] the same process by which pharmacies can administer flu shots," he says.

Susan McCreavy, a health educator who runs the HIV program at the Deschutes County Needle Exchange, says the program is in need of more funding. "It was cut in 2010, to just a little bit of staff," she says. "We're in the process of trying to rebuild that in light of the opioid problem across the country and in Deschutes County." Last quarter, McCreavy says 3,500 needles were exchanged at four needle exchange boxes located in Deschutes County. "The Needle Exchange program exists to prevent HIV, Hepatitis C, and to keep needles out of the community and out of the park," she says.

Finding help

Before seeking treatment at a methadone clinic, Marissa says, "I had a horrible perception and I thought that they were terrible places for the worst druggies ever." People tell her how bad methadone is, but she disagrees. "It's not a perfect program, but it's really helped me greatly," she says. "I mean in a way it's helped save my life."

For now, Marissa battles with depression, anxiety, experiencing highs and lows, from her drug use and now sobriety. Although she can't talk about her rock bottom experience, she says, "There are so many things that I wish I could have done differently, but if I had done them differently, then I wouldn't be the same person that I am right now," she says. She adds, "I've not only learned from it, but it's helped shape my personality today just like anyone."

Editor's Note: For this story, the reporter interviewed her sister. If you or someone you know is suffering from an opioid addiction, please contact Deschutes County Public Health or the National Opiate Hotline (877) 647-2177.